EL-17-1365 Permit- ' 13,G!
Miami Shores Village �tt?711�T ���trical Resid ttiai
10050 N.E.2nd Avenue NE MIT
$10SWfiCatafi n After lonr
Miami Shores,FL 33138-0000
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Phone: (305)795-2204 "
Issue 1) t 671512017 Expiration: 1 1212017
Project Address Parcel Number Applicant
987 NE 96 Street 1132060143240
THOMAS JOHNSON
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
THOMAS JOHNSON 987 NE 96 Street (206)351-1870
MIAMI SHORES FL 33138-
987 NE 96 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 2,100.00
REEVE AIR CONDITIONING INC (954)962-0252
_... .... _.. w, w. �..�_.r. ,N _.. ..,. Total Sq Feet: 0
I
Type of Work:FOR WIRING OF TWO MINI SPLITS AC U Available Inspections:
Additional Info: Inspection Type:
Classification:Residential
Review Electrical
Scanning:1
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.80 Invoice# REV-6-17-64059
DBPR Fee $2.25 05/18/2017 Check#:11120 $50.00 $ 112.30
DCA Fee $2.25
Education Surcharge $0.60 06/15/2017 Check#:11059 $ 112.30 $0.00
PermitFee-Additions/Alterations $150.00
Scanning Fee $0.00
Scanning Fee $3.00
Technology Fee $2.40
Total: $162.30
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AF IDAVIT: I certify that I the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction zoning. Futhe o ,I authorize the above-named contractor to do the work stated.
June 15, 2017
or' d Si ature:Owner Applicant / Contractor / Agent Date
Buil ng Department Copy
June 15,2017 1
S�r� 2 �O�VtgveZ
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Miami Shores Village
Building Department RECEIVED
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 MAY 18 207
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(30S)762-4949
FBC 20 l(-A�
BUILDING Master Permit No. [r ` (_t I ( �
PERMIT APPLICATION sub Permit No. �7(�n +-
❑BUILDING dELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:] CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOBADDRESS:
City: Miami Shores County: Miami Dade Zia:
Folio/Parcel#: 11'32U to—�l`� 3 Z'�t7 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: V 5 Flood Zone:_ BFE: FFE:
OWNER:Name(Fee Simple Titleholder): Phone#: (2.06-) 3S l-1 P l O
Address: °�cCj� H `i( 1�7 1.
City: State: Zip:
Tenant/Lessee Name: a Phone#:
Email:
CONTRACTOR:Company Name: '/"l L A �° , Phone#: 1
Address:
/� ZOO AAV �� l9w /
City: Y- "O"e'.5 state: �FI Zip: 3 7�
Qualifier Name: .5o-0-77- —t_A,,e.S1e_ — Phone#:
State Certification or Registration#: 6C %SMI 9 73� Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ b • e' Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ® Repair/Replace ❑ Demolition
Description of Work: 01'- 17 �ili 17�s k
Specify color of color thru tile:
Submittal Fee$ �� Permit Fee$ CCF$ ' ` CO/CC$ 0
Scanning Fee OC3 Radon Fee$ `�S DBPR$ Notary$
Technology Fee$ 2— 40 Training/Education Fee$ 0 `60 Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ 112 - 30
(Revised02/24/2014)
a
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES,BOILERS,HEATERS,TANKS,AIR CONDITIONERS,ETC.....
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. /n the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature011
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
30 day of 'v I I"""G' 20 � � ,by ��y-,qf
�0 day of � /k R C f'I .20 ) `� by
�s `�a��Sb- who is personally known to or— who is personally known to
me or who has produced VS �� ►f� as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign- Sign
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Print: _ ��h.�at, Print:
Seal: ...... i�I���� Seal:
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NOTARY = realm •FF IUM6
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PMMj 1e,+��Yry a M�owwaa�►
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APPRQt Plans Examiner Zoning
WASN����.
I1IIIIN0
Structural Review Clerk
(Revised02/24/2014)
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MAY 18 2017
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